Psychometric properties of the health literacy instrument in Brazil (HLS-EU-BR47)

Background Health literacy (HL) is a key component of health promotion and sustainability and contributes to well-being. Despite its global relevance, HL is an under-researched topic in South America but is now debuting its exploration in Brazil. To leverage its benefits for South America, the mere translation of validated tools into Portuguese is insufficient. Rather, it is necessary to examine their validity. This study aims to assess the psychometric properties of the European Health Literacy Questionnaire (HLS-EU-BR47) using the Item Response Theory (IRT) in a population-based sample of adults in Brazil. Methods A cross-sectional online study was conducted across Brazil and included 1028 participants aged 18 years and above (80% women). Cronbach’s alpha, McDonald’s omega, factor analysis, graded responses model, Item Characteristic Curve, HL levels based on this, HL standard calculation, IRT, and regular score correlation were computed. Results The instrument exhibit high reliability (Cronbach’s alpha 0.95). Factor analysis yielded one factor. IRT was appropriate for data analysis because it allowed quality evaluation of items and constructed a scale to quantify HL. The 47 items and latent features of respondents in the same unit of measurement are positioned in the construction of the HLS-EU-BR47 instrument. The percentages of individuals at each HL level, calculated using IRT, were found to be comparable to those obtained through the standard computation, e.g., 3.2% of people reported very low HL versus 10.8% inadequate HL, 56.2% reported low HL versus 39.5% problematic HL, 31.1% had moderate HL versus 30.1% sufficient HL, and 9.5% had high HL versus 19.7% with excellent HL. The mean HL scores were comparable between women and men (33.9 vs. 33.7, P = 0.36). Conclusion This study provides new evidence of the validity of a widely used HL instrument for the population of South America (in this case, Brazil). This tool can be utilized by citizens, health professionals, and regional/national policymakers to inform the development of initiatives to assess and improve the HL of individuals, groups, and communities. Further studies are needed to confirm and extend the findings and to explore the influence of local cultures and practices in the vast Brazilian territory on HL. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-024-19108-2.

Lizandra Brasil Estabel and is registered within the CEP/UFRGS.The estimated time to answer all the questions is approximately 30 minutes.The study aims to answer the question: How do people in the community express their information needs and the level of health literacy related to disease, quality of life and health promotion within the BiblioSUS Network?The objectives are to identify the information needs and the level of health literacy related to disease, the quality of life and the health promotion of the community in accessing and using the BiblioSUS network and analyzing community needs in relation to Technologies of Information and Communication (ICT).The data collected by this online survey will be used for academic purposes, in partnership between the Federal University of Rio Grande do Sul (UFRGS) and the Ministry of Health, preserving its confidentiality and guaranteeing the secrecy of the information collected.Thank you for the information provided.We are available for any clarification.
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There are no right or wrong answers.The results obtained are confidential and used for purely statistical purposes.Please indicate the time when you will start filling out the survey: 2) Health Literacy (HL) perception, measured with an instrument with 47 items described below (In English) 8…understand your doctor's or pharmacist's instruction on how to take a prescribed medicine 9…judge how information from your doctor applies to you? 10…judge the advantages and disadvantages of different treatment options?11…judge when you may need to get a second opinion from another doctor?12…judge if the information about illness in the media is reliable?(e.g., TV, Internet or other media) 13…use information the doctor gives you to make decisions about your illness?14…follow the instructions on medication?15…call an ambulance in case of an emergency?16…follow instructions from your doctor or pharmacist?(Health literacy dimension: diseases prevention) 17…find information about how to manage unhealthy behaviour such as smoking, insufficient physical activity and drinking too much alcohol?18…find information on how to manage mental health problems such as stress or depression?19…find information about vaccinations and health screenings that you should have?(e.g., breast examination, blood sugar test, blood pressure) 20…find information on how to prevent or manage conditions such as being overweight, high blood pressure or high cholesterol?21…understand health warnings about behaviour such as smoking, low physical activity and drinking too much?22…understand why you need vaccinations?23…understand why you need health screenings?breast exam, blood sugar test, blood pressure 24…judge how reliable health warnings are, such as smoking, low physical activity and drinking too much?25…judge when you need to go to a doctor for a check-up?26…judge which vaccinations you may need?27…judge which health screenings you should have?(e.g., breast examination, blood sugar test, blood pressure) 28…judge if the information on health risks in the media is reliable?(e.g., TV, Internet or other media) 29…decide if you should have a flu vaccination?30…decide how you can protect yourself from illness based on advice from family and friends?31…decide how you can protect yourself from illness based on information in the media?(e.g., newspapers, leaflets, Internet or other media) (Health literacy dimension: health promotion) 32…find information on healthy activities such as physical activity, healthy eating and nutrition?33…find out about activities that are good for your mental well-being?(e.g., meditation, exercise, walking, pilates) 34…find information on how your neighbourhood could be more health-friendly?(e.g., reducing noise and pollution, creating green spaces, leisure facilities) 35…find out about policy changes that may affect health?(e.g., legislation, new health screening programmes, changing of government, restructuring of health services etc.) 36…find out about efforts to promote your health at work? 37…understand advice on health from family members or friends?38 …understand information on food packaging?39…understand information in the media on how to get healthier?(e.g., Internet, newspapers, magazines) 40…understand information on how to keep your mind healthy?41…judge how where you live affects your health and well-being?(e.g., your community, your neighbourhood) 42…judge how your housing conditions help you to stay healthy?43…judge which everyday behaviour is related to your health?(e.g., drinking and eating habits, exercise) 44…make decisions to improve your health?45… join a sports club or exercise class if you want to? 46…influence your living conditions that affect your health and well being?(e.g., drinking and eating habits, exercise) 47…take part in activities that improve health and well-being in your community?
3) Demographic information 2) Level 1 (Elementary School I or first level of basic education) 3) Level 2 (Elementary Education II or second stage of basic education) 4) Level 3 (high school or secondary school) 5) Level 4 (technical or technological course) 6) Level 5 (higher education -graduation) 7) Level 6 (lato sensu graduate/specialization) 8) Level 7 (stricto sensu postgraduate -Master's, Doctorate, Postdoctoral and MBA) 9) I can't read or write 10) Does not respond Please now select the "send" or "submit" button to submit your questionnaire.Thank you for your participation!

Health literacy dimension: diseases care)
6…understand the leaflets that come with your medicine?7…understand what to do in a medical emergency?